Health care utilization and costs among patients with ad with and without dysphagia

Document Type

Article

Abstract

OBJECTIVE:: To assess health care utilization and associated costs among patients with Alzheimer disease (AD), with and without dysphagia. METHODS:: MarketScan Commercial and Medicare databases were analyzed. Patients with a diagnosis of AD with and without dysphagia between October 2006 and September 2010 were included. Acetylcholinesterase inhibitor usage, the number of outpatient and emergency room (ER) visits and hospitalizations, and associated health care costs were assessed. All variables were measured 1 year after the initial diagnosis of AD at the patient level. Patients with dysphagia were matched to patients without dysphagia using propensity score-matching (PSM) methods. Regression models were conducted to compare utilization and costs between the 2 groups. RESULTS:: A total of 485 patients with dysphagia and 8492 patients without dysphagia were included. Before matching, patients with dysphagia were older (81.1 vs. 79.8 y), and had higher Charlson Comorbidity Index scores (2.4 vs. 1.7). After matching, all baseline covariates were not statistically different between the 2 groups. Multivariate regression results showed that patients with dysphagia had a higher likelihood of all-cause hospitalizations [odds ratio (OR)=2.26, 95% confidence interval (CI)=1.70-2.99, P=0.001] and all-cause ER visits (OR=1.45, 95% CI=1.12-1.87, P=0.007) compared with patients without dysphagia; they also had a higher likelihood for AD-related hospitalizations and ER visits. The difference in all-cause total health care, ER, and hospitalization costs between patients with and without dysphagia were $3620 (95% CI=$2863-$4375), $258 (95% CI=$241-$274), and $3547 (95% CI=$3325- $3770), respectively. CONCLUSIONS:: This study suggests that patients with AD and dysphagia have higher health care utilization and costs compared with patients without dysphagia. Copyright © 2013 by Lippincott Williams & Wilkins.

Publication Date

4-1-2013

Publication Title

Alzheimer Disease and Associated Disorders

ISSN

08930341

Volume

27

Issue

2

First Page

138

Last Page

144

PubMed ID

22596081

Digital Object Identifier (DOI)

10.1097/WAD.0b013e318258cd7d

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